Provider Demographics
NPI:1982647921
Name:LECORPS, PATRICK J (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:LECORPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 KATY LN
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2300
Mailing Address - Country:US
Mailing Address - Phone:573-785-5599
Mailing Address - Fax:573-785-9559
Practice Address - Street 1:2346 KATY LN
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2300
Practice Address - Country:US
Practice Address - Phone:573-785-5599
Practice Address - Fax:573-785-9559
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002002065207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205858004Medicaid
MO163776OtherBLUE CROSS
B04617Medicare UPIN
MO163776OtherBLUE CROSS
MO001013698Medicare PIN